Johns Hopkins Health Alert
Hormonal Treatment for Recurrent Prostate Cancer
In our Special Report on Advanced Prostate Cancer Treatments, Dr. Jacek Mostwin, Professor of Urology at Johns Hopkins, answers questions on hormonal treatment for recurrent prostate cancer. Here are some of Dr. Mostwin’s comments.
In the ongoing war against prostate cancer, researchers are making progress. Twenty years ago, many of the men diagnosed with prostate cancer clearly had tumors that had extended beyond the prostate. However, thanks to the PSA (prostate-specific antigen) test, men are now being diagnosed much earlier, when the cancer is still within the prostate and they can be cured with a radical prostatectomy.
In the past, about 40 percent of men experienced a detectable PSA level within ten years after undergoing a radical prostatectomy. This number is dropping and will continue to do so as more men have their cancer detected early. Still, the return of PSA after an initial prostate cancer treatment is a distinct possibility that strikes fear in every cancer patient.
A rise in PSA means that a few cells escaped from the prostate before it was removed or irradiated, and have now grown to the point where they've produced enough PSA to raise concern.
What to do when the PSA becomes detectable? The good news is you may not need to do anything for years.
This may come as a surprise to many prostate cancer survivors who feel the best course of action for recurrent cancer is immediate treatment. But men need to understand that at this point there is no known cure. Frequently, physicians recommend (or patients request) starting hormone treatment to reduce PSA. This does not cure the disease and is sure to impact adversely on a man's quality of life.
The optimal time for initiating hormonal therapy remains unknown. In general, treatment is given when the cancer has spread to other areas of the body, such as the lymph nodes, liver, lungs or bones; when the patient is wracked with bone pain; or when there is a large mass of cancer obstructing the kidneys or bladder. In such cases, radiation therapy is used to control local symptoms, such as bone pain, caused by metastasis.
Hormonal therapy is very effective in causing a remission, improvement in pain and reduction in tumor mass and PSA levels for some time. Unfortunately, most patients eventually develop resistance to treatment and the cancer grows again.
Posted in Prostate Disorders on July 28, 2011
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